Military treatment facilities are set to resume billing civilians for medical care after a three-year pause, affecting an estimated 137,000 individuals who received treatment since June 21, 2023. This policy change comes following a provision in the 2023 National Defense Authorization Act that allows the Department of Defense (DOD) to implement a new billing program aimed at protecting non-beneficiary patients from financial distress.
New Billing Program Details
Civilians who are not eligible for military medical care, including Department of Defense civilian employees and others who received emergency treatment, will now receive bills from military hospitals and clinics. These facilities have the legal authority to provide care to ineligible individuals under certain conditions, usually on a reimbursable basis. However, the high costs associated with this care had placed some patients in financial hardship.
To address these concerns, Congress enacted a provision allowing the DOD to apply a sliding fee scale and catastrophic fee waivers for affected patients. The billing process had been paused to develop the Military Health System Modified Payment and Waiver Program, designed to assist civilians facing financial difficulties when they receive their medical bills. Officials encourage all non-beneficiary civilians to take advantage of this program when they are billed.
Financial Relief and Application Process
Once a patient is billed, they are advised to apply for financial aid if they encounter challenges in paying. The Defense Health Agency has stated that instructions for applying for financial relief will accompany each bill. Applications will be evaluated according to the standards set forth in the program’s final rule, which became effective on March 9, 2023.
Each bill will vary based on the type and length of treatment received, and individuals with other health insurance will have claims filed on their behalf by the military facility. However, they will still be responsible for copays, coinsurance, deductibles, and any non-covered services. Those without health insurance will receive direct bills from the military treatment facility.
The final rule guarantees flexible installment plans, allowing patients to spread their payments over a period of up to 72 months. Additionally, it establishes a sliding fee discount based on the Federal Poverty Guidelines. Patients with an annual household income at or below 100% of these guidelines may qualify for a full discount, while others will receive discounts based on a sliding scale.
For example, in the United States, a household of four with an annual income of $32,150 in 2026 would be at 100% of the federal poverty level. Comprehensive instructions for applying for financial relief can be found on the program’s webpage. Additionally, patients can reach out to the Defense Health Agency’s Debt Adjudication office for assistance during business hours.
This resumption of billing marks a significant shift in how military medical facilities handle civilian care, aiming to provide necessary financial relief while ensuring the sustainability of military healthcare services.
